Treatment of Pediatric Open Femoral Fractures with External Fixator Versus Flexible Intramedullary Nails

Document Type : RESEARCH PAPER

Authors

1 Tehran University of Medical Science, Tehran, Iran.

2 Shohada Teaching Hospital Tabriz University of Medical Sciences, Tabriz, Iran.

3 Poursina Teaching Hospital Guilan University of Medical Sciences, Guilan, Iran.

Abstract

 
Background: In children, inappropriate treatment of open femoral fractures may induce several complications. A few studies have compared the external fixator with flexible intramedullary nails in high-grade open femoral fractures of children. The present study aims at comparing results of these two treatment methods in open femoral fractures.
Methods:
In this descriptive analytical study, 27 patients with open femoral fractures, who were treated using either the external fixator (n=14) or TEN nails (n=13) method from 2006-2011, were studied. Some patients were treated with a combination method of TEN and pin. The results were evaluated considering infection, union, malunion, and refracture and the patients were followed up for two years.
Results:
Mean time required for fracture union was 3.89 (range: 2-5.8) and 3.61 (range: 2-5.6) months for the external fixator and TEN groups, respectively. The difference was not statistically significant and there was not any significant difference between the two groups considering infection of the fractured area. Osteomyelitis was not observed in any group. There was an infection surrounding the external fixator pin in 4 cases (28.5%) and so this required changing the location of the pin. In the TEN group, one case (7.6%) of painful bursitis was observed at the entry point of TEN and so the pin was removed earlier than usual. There were two cases (14.2%) of femoral refracture in the external fixator group. Malunion requiring correction was not observed in any of the groups. There were no complications observed in five patients treated with a combined method of pin and flexible intramedullary nails.
Conclusion:
Both external fixator and intramedullary nail methods are effective ways in treating high grade open femoral fractures in children and final treatment results are similar. Combining pins and flexible intramedullary nails is effective in developing more stability and is not associated with more complications.

Keywords

References

  1. Hutchins C, Sponseller P, Sturm P, Mosquero, R. Open femur fractures in children: treatment, complications, and results. J Pediatr Orthop.2000; 20:183–8.

  2. Wright JG, Wang  EL, Owen LJ, Stephens D, Graham KH, Hanlon M, et al. Treatments for paediatric femoral fractures: a randomized trial. Lancet. 2005; 365: 1153–8.

  3. Canale ST, Tennessee M, Tolo VT. Fractures of the femur in children. J Bone Joint Surg Am. 1995; 77:294-315.

  4. Levy J, Ward WT. Pediatric femur fractures: an overview of treatment. Orthopedics. 1993; 16:183-90.

  5. Gregory RJ, Cubison TC, Pinder IM, Smith SR. External fixation of lower limb fractures in children. J Trauma. 1992;33:691-3.

  6. Krettek C, Haas N, Walker J, Tscherne H. Treatment of femoral shaft fractures in children by external fixation. Injury. 1991;22:263-6.

  7. Skak SV, Overgaard S, Nielsen JD, Andersen A, Nielsen ST. Internal fixation of femoral shaft fractures in children and adolescents: a ten to twenty one year follow up of 52 fractures. J Pediatr Orthop. 1996;5:195-9.

  8. Ward WT, Levy J, Kaye A. Compression plating for child and adolescent femur fractures. J Pediatr Orthop. 1992; 12:626-32.

  9. Beaty JH, Austin SM, Warner WC, Canale ST, Nichols L. Interlocking intramedullary nailing of femoral-shaft fractures in adolescents: preliminary results and complications. J Pediatr Orthop. 1994; 14:178-83.

  10. Allison P , Dahan-Oliel N, Jando VT, Su Yang S, Hamdy RC. Open fractures of the femur in children: analysis of various treatment methods. J Child Orthop. 2011; 5:101–8.

  11. Barlas K, Beg H. Flexible intramedullary nailing versus external fixation of paediatric femoral fractures. Acta Orthop Belg. 2006; 72:159-63.

  12. Griffet J,  Leroux J, Boudjouraf N, Abou-Daher A, Hayek T. Elastic stable intramedullary nailing of tibial shaft fractures in children. J Child Orthop. 2011; 5:297–304.

  13. Ligier JN, Metaizeau JP, Prevot J. Closed flexible medullary nailing in pediatric traumatology.Chir Pediatr. 1983; 24:383-5 .

  14. Pankovich AM, Tarabishy IE, Yelda S. Flexible intramedullary nailing of tibialshaft fractures. Clin Orthop.1981; 160:185-95.

  15. Abdel Razak MY, El Karef EA, Soleiman AS, Tanagho A. Results of flexible intramedullary nailing in peadiatric femoral fractures. Bull Alex Fac Med. 2008;44:729-35.

The Archives of Bone and Joint Surgery
Volume 1, Issue 2 - Serial Number 2
December 2013
Pages 64-67

Files

History

  • Receive Date: 14 September 2013
  • Revise Date: 22 November 2013
  • Accept Date: 09 December 2013

Share

How to cite

Statistics